HomeMy WebLinkAboutGW1--04616_Well Construction - GW1_20240809 •
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North Caroline Depoiwocnt of Eaniromoot and I -Rpe:Qom-Dim of Water Quay .
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" -Wail Grebe elbl'E'ongraay Mime From TO - From TO
TAppRos 204 Tom Aye - 7. GAO N& • TWAIN, - .
Gsstle.Hayne NC 28429 From DToe 1� A. `Diersele c VlielOpt46 1r
- City or Tawq Slade Zip Code From _Ft
-(910 }.231.8889- From - To Ft, •
Area code- Plrone number
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3.WELL U.SE(Check Bu*�Reetderdid Wader Srlppdy 1 Fratrm T - - Ft b. - h.
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DATE DRILLED -Q,"1 - Fe . _ 1 _Ft__.__M. i.
Tt1E COWLETED 6:00 AM* P - • • From To FL In. in.
e 111ELL LOCATION: _ - • is SAND/GRAVEL PACK: -
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TOPOGRAPHIC/LAND SETTTNOc
1 Slope I Valley 1 net I Ridge 1 Other -
(m„m sePoy b 11.DRLLWG LOG •
LATITUDE _ boy.be is deems. From To - Fomartion DesOipiion -. --
mmraes,second.or
LONGTTiIDE _ ILA•a baud forma 5`. ,�lyr� r 1� M i
'' 1- Laditoddloogitude-soowoc: I OPS -1 Topographicfop .A 1 I b CC 1
pocoOon aired must be shorn on a USES Inns mop and l
.attached b this Iona idiotusing(iPS) l'al0-4 L i Mst'4 N
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WELL
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STREET ADDRESS O( )yq -s�1<<t4.1-- 0 C
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arToNr Stale
. kes rode-Phone number . - • 12. RBMARM:
a .L DETAIL& . -
_ 4 T11:r} TOTAL U , l-
IL DOEi.INELL REPLACE E>O¢7 01E1.LY YESI NO1 rmMENEM CERTIFY THAT1HBWetVHSCONSITarCHEDmAo00RIVACEMTH -
�1 d ITANCAC3C.VALI0 r1SIRUCT10MST/ADMI AND HATA COPY OFmil
C. WATB!LEI/EL.Ebbw Tap of C a O FT. RBcomnes TOT E WM_OMER -
(lase-'+-sAbove Top ofCoNO), - �j Q
- d. TOP OF CASINGts 4. FT_Above Land surface* �! V- f-c2�
. . •'Top of i:atine Iendrmled altar baba Iend:Ur ohm may require siGiA DF WEU CONTRACTOR DATE
of towboat In Saoorroe with15A NCA(2C A116. •A' C.Sage - _
a, YE.D-(gpnr* 1(f) Noma opTESTA;C_t',+t ' PRIIEO NAME OF PERSON CONSTRUCTING LING THE NULL
- lkdohit theecrigintito the Division of Wa-Quirnywithin30slays. AWE io Ent.&n Mgt., - Fi` n Allf-3
11117 iMai}Service censer—Raleigh.IIC 770E9-4117 Phone No.DPW)733:761rs eau.c.___